Ancillary Network Specialist

Blue Cross Blue Shield of Massachusetts • Boston, MA

1d

About The Position

Ready to help us transform healthcare? Bring your true colors to blue. The Ancillary Network Specialist will be responsible for managing assigned ancillary professional and institutional provider types. The Ancillary Network Specialist will be responsible for managing the contract maintenance process for assigned provider networks and assist with the variety of tasks that are necessary for the maintenance of our Ancillary provider networks (Enrollment/Credentialing, claims questions, contract operations) In addition, the Network Specialist will help simplify the way providers conduct business with BCBSMA to improve the overall provider experience. The Day to Day: Support Ancillary Network Managers in overall management of assigned providers: Understand all operational aspects of BCBSMA’s contracting workflow and procedures for ancillary professional and institutional providers Instruct and educate new providers/office staff regarding BCBSMA products, network application and contracting processes. Understand and promote the medical operations system, including referral management, provider enrollment, credentialing and reimbursement Record provider feedback, network and market intelligence, and key provider concerns and issues Develop and negotiate contracting approaches and methodologies which maximize Blue Cross’s competitive position and support its strategic vision of making quality health care more affordable. Respond to both internal and external customers regarding provider contractual arrangements, both for contract implementation and ongoing operations. Single point of contact for areas of the company that we work closely with (enrollment, claims, medical management) Assist in the creation, development, and implementation of new workflows that support internal and external departmental processes Promote and support the use of provider self-service technologies Respond to provider inquiries and handle issues: Responsible for first response / triage of inquiries and issues Autonomously resolve, in timely manner, provider issues escalated by BCBSMA Senior Management or internal departments, as appropriate Communicate key information to leadership and make recommendations for process improvements Communicate with internal departments to convey feedback from ancillary professional and institutional providers and identify operational issues Manage contractual requirements of BCBSMA and providers: Utilize contract management system to initiate all boilerplate provider contracts while managing inventory within established turnaround times Manage provider movement into, out of, and within contracts Monitor BCBSMA contractual requirements and coordinate among internal business areas to ensure timely adherence Monitor providers’ contractual requirements and follow-up with providers as needed This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Employees may be required to perform other job-related duties.

Requirements

• Knowledge of the healthcare industry (preferably ancillary providers) including local/regional nuances and plan and provider operations
• Understanding of provider contract development; demonstrated understanding of health care reimbursement methods and strategies including experience negotiating with providers.
• Excellent written and interpersonal communication skills including the ability to communicate with confidence, adapt personal style to the audience
• Excellent organizational skills with a focus on attention to detail.
• Demonstrated ability to establish, build and maintain relationships with internal and external constituents
• Ability to influence others to achieve mutually beneficial outcomes and inspire trust
• 3-5 years Healthcare/Provider Network Management experience preferred
• College Degree (BA/BS) required
• Strong computer system knowledge including Microsoft Office applications.
• Minimum Education Requirements: High school degree or equivalent required unless otherwise noted above

Nice To Haves

• Advanced Degree (MPH, MBA) preferred
• Experience with BCBSMA technologies a plus (including HURON, RTMS, TPS, Salesforce, Right Fax)

Responsibilities

• Support Ancillary Network Managers in overall management of assigned providers
• Understand all operational aspects of BCBSMA’s contracting workflow and procedures for ancillary professional and institutional providers
• Instruct and educate new providers/office staff regarding BCBSMA products, network application and contracting processes.
• Understand and promote the medical operations system, including referral management, provider enrollment, credentialing and reimbursement
• Record provider feedback, network and market intelligence, and key provider concerns and issues
• Develop and negotiate contracting approaches and methodologies which maximize Blue Cross’s competitive position and support its strategic vision of making quality health care more affordable.
• Respond to both internal and external customers regarding provider contractual arrangements, both for contract implementation and ongoing operations.
• Single point of contact for areas of the company that we work closely with (enrollment, claims, medical management)
• Assist in the creation, development, and implementation of new workflows that support internal and external departmental processes
• Promote and support the use of provider self-service technologies
• Respond to provider inquiries and handle issues
• Responsible for first response / triage of inquiries and issues
• Autonomously resolve, in timely manner, provider issues escalated by BCBSMA Senior Management or internal departments, as appropriate
• Communicate key information to leadership and make recommendations for process improvements
• Communicate with internal departments to convey feedback from ancillary professional and institutional providers and identify operational issues
• Manage contractual requirements of BCBSMA and providers
• Utilize contract management system to initiate all boilerplate provider contracts while managing inventory within established turnaround times
• Manage provider movement into, out of, and within contracts
• Monitor BCBSMA contractual requirements and coordinate among internal business areas to ensure timely adherence
• Monitor providers’ contractual requirements and follow-up with providers as needed

Benefits

• We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level